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HOUSE PUTS THE PRESSURE ON FOR SPENDING DEBATE — A House-passed bill to raise the debt ceiling for three months appears all but assured to enter the law books, giving the GOP exactly what it wants: an immediate debate on the nation’s spending habit. By delaying the default deadline, the next pressure points over the sequester and the expiration of government funding means a discussion of entitlements and other budget drivers are a natural fit. President Barack Obama has struck a more resistant posture on entitlement cuts in recent weeks, but Republicans are feeling bullish after coalescing behind a more aggressive strategy. Now, POLITICO’s David Rogers reports, Republicans are seeking $69 billion in additional appropriations cuts as leverage to force the president to cut Medicare, Medicaid and food stamps, or other benefit programs.

“Republicans see this as smart politics — or at least smarter than rattling financial markets with threats of default. And having extolled the virtues of government at his inaugural Monday, Obama is in for a refresher course on an appropriations process he has long ignored but that keeps his ambitions funded. It will be a messy March for all sides — a 2011 sequel in spades,” Rogers writes. http://politico.pro/10SM9yE

-- DÉJÀ VU: JAY CARNEY RIPS ‘VOUCHERIZED’ MEDICARE – The White House spokesman said President Obama’s reference to preserving entitlements during his second inaugural address was that Medicare, Medicaid and Social Security are economic engines, not detractors. “The insecurity that seniors face or would face if Medicare were voucherized and the costs were shifted to them if they had a limited amount of money to spend on health care and the rest was up to them, I think would not be good for the country. The president doesn't believe it's good for the country,” he said during his daily press briefing. We’ve heard this before, but in the context of the presidential election. The new context of budget negotiations further entrenches the White House against this fundamental refashioning of Medicare.”

Welcome to Thursday PULSE, where we’re marveling over the fact that lip-synch-gate has extended into a third straight day. The outrage probably stems from the fact that a sizeable portion of the crowd (admittedly anecdotal) appeared to have turned out precisely to hear Beyonce sing. In fact, PULSE witnessed several angry fans storm off when James Taylor’s performance was announced, only to sheepishly trot back when they realized Beyonce was still going to “sing.” Kelly Clarkson elicited a few boos too. Buzzfeed’s take: http://bit.ly/10J5L7A

“Through the fire, to the limit, to the wall. For a chance to be with PULSE, I'd gladly risk it all.”

** A message from SHOUT America: Many younger, healthier individuals could be surprised to see the cost of their insurance skyrocket 40 percent or more under the Affordable Care Act in 2014. What’s behind this? Calculate your cost at http://youngforaffordability.org/. **

TODAY ON POLITICO PRO:

--NELSON COMES FULL CIRCLE ON OBAMACARE — Recently retired Sen. Ben Nelson, who took heat at home for being the 60th vote in support of Obamacare, may have the last laugh. Pro’s Jason Millman reports that Nelson, newly appointed to head the National Association of Insurance Commissioners, will have an outsized role in implementing the Affordable Care Act. http://politico.pro/10KudoU

--CONGRESSMEN TAKE AIM AT AMGEN’S FISCAL CLIFF SPOILS — Turns out the fiscal cliff deal came with a golden parachute for one drug company. An under-the-radar provision of the legislation exempted certain drugs from government payment reform for two years, and Amgen was the only company pushing for the policy. http://politico.pro/10K4oFw

--PERMANENT DOC FIX? ONE REP WILL GIVE IT A TRY – Get psyched: The doc fix is coming. Or so Rep. Kevin Brady, newly minted chair of the House Ways and Means health subcommittee, seems to think. http://politico.pro/SDv0V3

LOUISIANA HOSPICE TURNAROUND – PULSE told you early this month about Louisiana Gov. Bobby Jindal’s plan to eliminate Medicaid hospice coverage as of Feb. 1. National media coverage picked up over the last few days, and lo and behold, the AP reported Wednesday night that Jindal changed his mind. The AP said, “Health and Hospitals Secretary Bruce Greenstein announced the reversal as hospice program supporters were gathering for a candlelight vigil on the state capitol steps to protest the cut. Greenstein said his department will use federal grant funding to continue the services for the poor and terminally ill.” The report: http://bit.ly/XB6K2Z

BACHMANN GETS 13 MORE TO JOIN REPEAL CAUSE — Rep. Michele Bachmann finally has some company on the “repeal Obamacare” bandwagon. Nearly three weeks after she filed a bill to eliminate the health law, 13 House Republicans signed onto her legislation this week, including three freshmen (Reps. Doug LaMalfa, Luke Messer and Robert Pittenger) and two members of the GOP Doctor’s Caucus (Reps. Tom Price and John Fleming). The others are Reps. John Abney Culberson, Louie Gohmert, Jim Jordan, Doug Lamborn, Billy Long, Mick Mulvaney, Bill Posey and Steve Scalise. Reps. Steve King and Steven Palazzo signed onto a separate bill to repeal the ACA, bringing the total number of confirmed repeal sponsors to 16 in this Congress.

--A smaller scale bill, filed this week by Rep. Alan Nunnelee (R-Miss.) would prohibit two multistate insurance plans — required under the ACA — from covering abortion. In floor remarks Tuesday, Nunnelee described the bill as an attempt to “protect taxpayers from funding abortion.” “The bill that was introduced earlier today would simply prevent those plans from paying for abortions, thus making sure that taxpayers around the nation are not required to subsidize the taking of life,” he said. “Now this isn't new policy, in fact, it's simply an extension of longstanding federal policy, and that's why I urge my colleagues to support this bill.” http://1.usa.gov/WVoVzG

AND ON THE SENATE SIDE … Sen. Orrin Hatch (R-Utah) and 17 Republican co-sponsors filed a bill Tuesday to repeal the ACA’s individual mandate. The only newcomer on the list is Sen. Deb Fischer of Nebraska. The bill is headed to the Senate Committee on Finance.

--SENATORS FILE MENTAL HEALTH BILL – Democrat Jack Reed of Rhode Island and Republican Lisa Murkowski of Alaska introduced a bill to reauthorize programs aimed at preventing youth suicide and shoring up mental health services for young people. “The horrific mass shootings we’ve seen at schools across the country shows that more work must be done to address the mental and behavioral health of children and young adults before they hurt themselves and others,” Reed said in a statement.

RYAN: WE HAVE TO GET SAVINGS FROM ENTITLEMENTS TO SAVE THEM — House Budget Committee Chairman Paul Ryan expects the House and Senate to offer competing visions for the federal budget, but that doesn’t mean the GOP plans to gut the social safety net. “I think we have to get savings from these programs in order to save these programs. But by reforming these programs, that does not mean that you are against these programs,” he said, according to a transcript from a Wall Street Journal breakfast. “That does not mean that you think less of these programs or think less of the people who are on these programs, like my mom. This means — by reforming these programs, this means we want to make sure that they’re working.”

NCPA SURVEY: PART D RECIPIENTS FEARFUL OF MAIL-ORDER DRUG IMPACT– A survey by the National Community Pharmacists Association released Thursday suggests seniors are fearful of losing pharmacy access if their Medicare Part D plans required them to get their drugs by mail. Nearly two-thirds said so, according to the survey of 669 Medicare Part D beneficiaries. “Mail order is not for everyone. In fact, consumers have said that it’s not for most people,” NCPA CEO B. Douglas Hoey said in a statement. The survey also found that more than half of respondents thought they’d lose access to a particular pharmacist they trust. http://bit.ly/10LeNkj

PULSE CORRECTION: REALITY SHOW ON HEALTH NOT A REALITY — At least not yet. A helpful reader pointed out that an item contributed by one of PULSE’s colleagues yesterday morning about a health-care-themed reality TV show made it sound like the show was already in development — and it’s not. “Maybe we need a show like this. For readers who haven’t looked at the references yet, there is no reality show, except in my imagination,” Dr. Wendy Lynch, director of the Altarum Center for Consumer Choice in Health Care, specifies at the end of her article. Sorry we didn’t notice right away — we were too busy imagining the season finale.

MASS. GOVERNOR, AN EARLY ACA SUPPORTER, OUTLINES FIRST-YEAR IMPACT – Gov. Deval Patrick estimates that his state’s Medicaid program will surge by 325,000 next fiscal year, thanks to the full implementation of the ACA and shifting residents off of existing subsidized health programs. Patrick rolled out his FY 2014 budget blueprint Wednesday, describing a raft of new health care initiatives — including a pilot program to coordinate care for dual eligibles and a plan to bolster exchange subsidies with an additional state “wrap.” In all, though, he estimates that the implementation of the health law will ease the state’s budget pressure by about $205 million, a combination of savings, and new revenue, much of it from Washington. http://1.usa.gov/SDczja

HAPPENING TODAY — The Senate HELP Committee holds a hearing on the nation’s mental health system, featuring testimony from SAMHSA Administrator Pamela Hyde and Thomas Insel, director of the National Institute of Mental Health. The 10 a.m. hearing is in Dirksen 430.

WHAT WE’RE READING, by Brett Norman

The AP’s Ricardo Alonso-Zaldivar details a political quandary for some governors on the Medicaid expansion option: A provision in the ACA would force some U.S. citizens to go without coverage but make it available to legal immigrants. http://bit.ly/Umo6Db

The people who are trying to repeal IPAB should take notice that even if the board goes away, the ACA would still give the cost-cutting authority to the HHS secretary, National Journal reports. http://bit.ly/Wh4wcb

Reuters reports that the WellPoint executive VP who oversees company Medicaid business said that the “economic benefits” of Medicaid expansion will compel most states to do it, early resistance notwithstanding. http://reut.rs/WLLrwz

And The Washington Times looks at GOP governors still wrestling with the expansion, even as some of their colleagues have taken the feds up on their offer because of the generous terms. http://bit.ly/UXhom3

FDA decided not to appeal a legal decision that seems to limit the agency’s ability to regulate off-label marketing, The Wall Street Journal reports. http://on.wsj.com/10SXLlq

A major Catholic health care company, Catholic Health Initiatives, is defending itself in a malpractice suit by arguing that fetuses are not people with legal rights, The Colorado Independent reports. http://bit.ly/UkKxIU

Obamacare protects most people from insurer discrimination but could allow much higher premiums for smokers — California Healthline’s Dan Diamond asks if smokers get a fair shake. http://bit.ly/WtivcN

Obamacare effectively denies Medicare funds to new physician-owned hospitals, but its value based purchasing program has found that they perform very well, Investors Business Daily reports. http://bit.ly/UmaOXl

** A message from SHOUT America: Many younger, healthier individuals could be surprised to see the cost of their health insurance increase dramatically, potentially skyrocketing 40 percent or more when new provisions from the Affordable Care Act go into effect in 2014. What’s behind this? New federal rating restrictions, including a 3 to 1 limit on the use of age, broader benefits, the health insurance tax, as well as other changes will cause the insurance premiums to increase disproportionately for younger, healthier Americans. Calculate your cost at http://youngforaffordability.org/. **